Current through all regulations passed and filed through September 16, 2024
This rule sets forth the data used to determine assessments and
adjustments, and the data policies that are applicable for each program year
for all providers of hospital services included in the definition of "hospital"
as described under section
5168.01 of the Revised
Code.
(A) Definitions.
(1) "Disproportionate share hospital" means a
hospital that meets the requirements for disproportionate share status as
defined in rule
5160-2-09 of the Administrative
Code.
(2) "Governmental hospital"
means a county hospital with more than five hundred beds or a state-owned and
-operated hospital with more than five hundred beds.
(3) "Hospital" means a hospital that is
described under section
5168.01 of the Revised Code.
(4) "Hospital care assurance
program fund" means the fund described under section
5168.11 of the Revised
Code.
(5) "Hospital care assurance
match fund" means the fund described under section
5168.11 of the Revised
Code.
(6) "Intergovernmental
transfer" means any transfer of money by a governmental hospital.
(7) "Health care
services administration fund" means the fund described under section
5162.54 of the Revised
Code.
(8) "Program year" means the twelve-month period
beginning on the first day of October and ending on the thirtieth day of
September.
(9) "Total facility costs" for each hospital means the
amount from the ODM 02930, "Ohio Medicaid
Hospital Cost Report," for the applicable state fiscal year, schedule B, column
3, line 202. For non-medicaid participating hospitals, total
facility costs shall be determined from the medicare cost report.
(10)
"Total skilled nursing facility costs" for each hospital means the amount on
the ODM 02930, schedule B, column 3, line 44. For non-medicaid participating
hospitals, total skilled nursing facility costs shall be determined from the
medicare cost report.
(11) "Total home
health facility costs" for each hospital means the amount on the ODM 02930,
schedule B, column 3, line 98. For non-medicaid participating hospitals, total
home health facility costs shall be determined from the medicare cost
report.
(12) "Total hospice facility costs" for each hospital
means the amount on ODM 02930, schedule B, column 3, line 99. For non-medicaid
participating hospitals, total hospice facility costs shall be determined from
the medicare cost report.
(13) "Total ambulance
costs" for each hospital means the amount on ODM 02930, schedule B, column 3,
line 95. For non-medicaid participating hospitals, total ambulance costs shall
be determined from the medicare cost report.
(14) "Total Durable
Medical Equipment (DME) rental costs" for each hospital means the amount on ODM
02930, schedule B, column 3, line 96. For non-medicaid participating hospitals,
total DME rental costs shall be determined from the medicare cost
report.
(15) "Total DME sold costs" for each hospital means
the amount on ODM 02930, schedule B, column 3, line 97. For non-medicaid
participating hospitals, total DME sold costs shall be determined from the
medicare cost report.
(16) "Other
non-hospital costs" for each hospital means separately identifiable
non-hospital operating costs found on worksheet B, Part I of the medicare cost
report, as determined by the department upon the request of the hospital, that
are permitted to be excluded from the provider tax in compliance with section
1903(w) of the Social Security Act.
(17) "Adjusted total
facility costs" means the result of subtracting the sum of the amounts defined
in paragraphs (A)(10), (A)(11), (A)(12), (A)(13),
(A)(14)and
(A)(15) of this rule from the
amount defined in paragraph (A)(9) of this rule.
(B) Source data for calculations.
(1) The calculations described in this rule
for each program year will be based on cost-reporting data described in rule
5160-2-23 of the Administrative
Code that reflects the completed interim settled medicaid cost report (ODM
02930) for each hospital's cost reporting period ending in the state fiscal
year that ends in the federal fiscal year preceding each program year. For
non-medicaid participating hospitals, the calculations will be based on the
medicare cost report for the same time period.
(a) For new hospitals, the first available
cost report filed with the department in accordance with rule
5160-2-23 of the Administrative
Code will be used until a cost report that meets the requirements of this
paragraph is available. If, for a new hospital, there is no available or valid
cost report filed with the department, the hospital will be excluded until
valid data is available.
(b) Data
for hospitals that have changed ownership shall be treated as described in
paragraphs (B)(1)(b)(i) to (B)(1)(b)(ii) of this rule.
(i) For a change of ownership that occurs
during the program year, the cost reporting data filed by the previous owner
that reflects that hospital's most recent completed interim settled medicaid
cost report shall be annualized to reflect one full year of operation. The data
will be allocated to each owner based on the number of days in the program year
the hospital was owned.
(ii) For a
change of ownership that occurred in the previous program year, the cost
reporting data filed by the previous owner that reflects that hospital's most
recent completed interim settled medicaid cost report and the cost reporting
data filed by the new owner that reflects that hospital's most recent completed
interim settled medicaid cost report, will be combined and annualized by the
department to reflect one full year of operation. If there is no available or
valid cost report from the previous owner, the department shall annualize the
cost report from the new owner to reflect one full year of operation.
(c) For hospitals involved in
mergers during the program year that result in the hospitals using one provider
number, the cost reports from the merged providers will be combined and
annualized by the department to reflect one full year of operation.
Cost report data used in the calculations described in this
rule will be the cost report data described in this paragraph and are subject
to any adjustments made upon departmental review that is completed each year
and subject to the provisions of paragraph (D) of this
rule.
(2) Closed
hospitals with unique medicaid provider numbers.
For a hospital facility, identifiable to a unique medicaid
provider number, that closes during the current program year as defined in
paragraph (A) of this rule, the cost report data shall be adjusted to reflect
the portion of the year that the hospital was open during the current program
year. That partial year data shall be used to determine the assessment owed by
that closed hospital.
Hospitals identifiable to a unique medicaid provider number
that closed during the immediate prior program year will not owe an assessment
for the current program year.
(3) Replacement hospital facilities.
(a) If a new hospital facility is opened for
the purpose of replacing an existing (original) hospital facility identifiable
to a unique medicaid provider number and the original facility closes during
the program year defined in paragraph (A) of this rule, the cost report data
from the original facility shall be used to determine the assessment for the
new replacement facility if the following conditions are met:
(i) Both facilities have the same
ownership,
(ii) There is
appropriate evidence to indicate that the new facility was constructed to
replace the original facility,
(iii) The new replacement facility is so
located as to serve essentially the same population as the original facility,
and
(iv) The new replacement
facility has not filed a cost report for the current program year.
(b) For a replacement hospital
facility that opened in the immediate prior program year, the assessment for
that facility will be based on the cost report data for that facility and the
cost report data for the original facility, combined and annualized by the
department to reflect one full year of operation.
(C) Deposits into the health care services
administration fund.
From the first installment of assessments paid under rule
5160-2-08.1 of the
Administrative Code and intergovernmental transfers made under rule
5160-2-08.1 of the
Administrative Code during each program year, the department shall deposit into
the state treasury to the credit of the health care services administration
fund, a total amount equal to the amount allocated by the appropriations act
from assessments paid under section
5168.06 of the Revised Code and
intergovernmental transfers made under section
5168.07 of the Revised Code
during each program year.
(D) Finalization of
data used for disproportionate share and indigent care adjustments.
During each program year, the department may
provide
any data the department may choose to use for disproportionate share and
indigent care adjustments, described in rule
5160-2-09 of the Administrative
Code, to each hospital. The department may mail the data or may make the data
available on the medicaid provider portal. The department will notify each
hospital of the availability of the data via regular or electronic mail
(e-mail). Not later than thirty days after the department mails
or e-mails the notification, any
hospital may submit to the department a written request to correct data. Any
documents, data, or other information that supports the hospital's request to
correct data must be submitted with the request. On the basis of the
information submitted to the department, the department may adjust the
data.
(1) For each program year,
thirty-days
after the expiration of all hospitals' thirty-day data correction
periods, the department shall consider the data correction period closed and
all data final, subject to review and acceptance by the department.
(2) Any hospital that requests to correct
data after the expiration of its thirty-day correction period but before the
data correction period is closed for all hospitals as described in paragraph
(D)(1) of
this rule, shall be subject to an administrative fee. The administrative late
fee shall be 0.03 per cent of the hospital's adjusted total facility cost as
calculated in paragraph (A)(17) of this rule. The hospital shall include
payment of the administrative late fee with the written request to correct
data.
(3) All amounts received by
the department under this paragraph shall be deposited into the state treasury
to the credit of the health care services administration fund, described under
paragraph
(A)(7) of this rule.
(4) The department shall accept at any time,
data from any hospital that has misstated its reported data used to make
disproportionate share and indigent care adjustments and that resulted in a
disproportionate share and indigent care payment that was greater than the
payment would have been with the corrected data.
(E)
Confidentiality.
Except as specifically required by the provisions of this rule
and rule
5160-2-24 of the Administrative
Code, information filed shall not include any patient-identifying material.
Information including patient-identifying information is not a public record
under section 149.43 of the Revised Code and
no patient-identifying material shall be released publicly by the department of
medicaid or by any person under contract with the department who has access to
such information.
Replaces: 5101:3-2-08
